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Poster D31, Thursday, November 9, 6:15 – 7:30 pm, Harborview and Loch Raven Ballrooms

What Matters about White Matter

Argye Hillis1, Amy Wright1, Sadhvi Saxena1, Bonnie Breining1, Rajani Sebastian1, Donna Tippett1;1Johns Hopkins University School of Medicine

Introduction Although numerous studies have shown that damage to particular white matter tracts disrupt specific language tasks, few studies have examined the role of leukoaraiosis (diffuse white matter disease) in both hemispheres on recovery of language after stroke. Based on the premise that the health of non-infarcted regions is critical to recovery from aphasia, we hypothesized that moderate to severe leukoaraiosis is associated with poor recovery of language after stroke, independently of the volume of infarct and time post onset. We focused on naming because naming deficits (measured with object naming and word fluency such as rapid animal naming) are the most common residual deficits in chronic aphasia. Methods We studied 42 adults, mean 39 ± SD 36 (range 3-157) months post stroke, with the Western Aphasia Battery (WAB) and brain MRI. Participants were mean age of 56.1 years ± SD 15.1 years, and had mean 14.8 ± 3.1 years of education. Scans were rated for the severity of leukoaraiosis by a neurologist and a technician masked to the language scores, using the Cardiovascular Health Study (CHS) rating scale (ranging from 0 to 9, with 9 being 'most extensive'). There was excellent interrater agreement in rating leukoaraiosis (kappa = 0.93). We tested the relationships between severity of leukoaraiosis and language scores (WAB Aphasia Quotient, object naming, word fluency) using Pearson correlations. Ten patients did not complete the entire WAB, so they had only naming and fluency scores. We tested the association between “good outcome” (highest quartile of each language score) and moderate to severe leukoaraiosis (≥5 on 0-9 scale) using chi square tests. We also used linear regression, with language scores as the dependent variable, and leukoaraiosis, lesion volume, and time post-onset as independent variables, to evaluate the contributions of each to recovery of language. Results Severity of leukoaraiosis negatively correlated with WAB AQ (r= -0.43; p=0.016), object naming (r=-0.47; p=0.0017), and word fluency (r=-0.36; p=0.019). Moderate to severe leukoaraiosis (CHS score ≥5) was negatively associated with highest quartile of object naming (chi squared = 4.7; p=.031) and word fluency (chi squared = 5.3; p=0.022). In multivariate analysis, severity of leukoaraiosis, lesion volume, and months post-onset together predicted recovery of object naming (p=0.036), but only the severity of leukoaraiosis was independently associated with recovery of object naming (p=0.01; CI -7.07 to -.85). Severity of leukoaraiosis was also the only independent (negative) predictor of recovery of word fluency (p=0.041) and WAB AQ (p=0.011) when we included infarct volume and months post-onset in the regression. Conclusions These results indicate that moderate to severe leukoaraiosis is associated with poorer recovery of naming and other language skills, independently of infarct volume and months post-onset of stroke. Results may help with prognosis. Further studies are needed to determine if leukoaraiosis can prospectively predict language recovery or response to treatment in larger, independent samples.

Topic Area: Language Disorders

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